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� NCJ'�CNOF/F<i S'I-�7 / � <br /> evere2t CHART ND l ' -�r-� <br /> - `' // � � <br /> J./ : � n...� 'L—_./ <br /> 4 � . � t <br /> , . . <br /> � City of Everett I „�, ' <br /> Engineering & Community Services � <br /> Sewer Application and Permit �- <br /> NO. `�; / � J DATE `= ��i�"•�� <br /> Service Address J�'-=`*"�' %�<'•- '/-.. - f�'/.�.-,,, Utility Account No. �- `'`-' - � ` � - ` " <br /> Billirg Address � i/� `s � C CG,.�.�.�, ! ' _. . ` ':. <br /> � Permit Fee <br /> City, State, Zip �..%�L�<'�77 �� ��� :� _ Cennection Charge�s) - ` � ' � "�'•f�7 <br /> , � � <br /> Owner (Mortgagor) �✓• 1'✓ • - �� ; %J ,��r""..', Total Fee � �' <br /> � Dilling Name �__ _ ; <br /> Connection By_ i <br /> � Address !, �il �' T�Z G.�., ' / � <br /> _�'.T Signed f1� 1 • , �(_i� �T <br /> E Cusromer I <br /> : <br /> Phone =.3- _a �' � <br /> I i <br /> DESCRIPTION: Sewer District -� ;-'• �- �� �i I <br /> Lot y�1 Block ^•: '� <br /> Plat��- .'-.-�._„� �::.,�.�.�L Monthly Sewer Service �� ' `- ��' <br /> ( Unplatted Description Monthly Sewer Constr. <br /> � <br /> �-., -- - <br /> Trunk � �`-- � <br /> Type Permit: �/�.._ _.- "'- <br /> — � .>`. <br /> I Lateral <br /> Remarks: '" " �- • . <br /> � � �/ � �7ly � � ��,f'� Abutting Lot Line <br /> � <br /> .-��.u'i'%�-,4(� �1'a _ <-,o _� N S EI W <br /> i . � ` �/.. . ft. <br /> 1 � �,r_,-✓ i✓ � .5 !L . C_ �- <br /> _.��;.-�` .. / �i '� % <br /> 4pprot,ed By ,--_" - f . , , <br /> _ C:[y Engineer , <br /> Issued By �__� <br /> � <br /> Inspection By--i,i��"> <br /> o Date Insper,te� �7 � 77 _ <br /> � SEE SKETCH ATTACHED � NO. <br /> Ii�;SPGG?IOi'. � � <br /> / ' � <br />